Early Childhood Connections

描述（由申请人提供）：接受儿童福利服务的幼儿在行为、心理健康和认知延迟方面的比例非常高，但这些儿童很少接受早期儿童干预（Cicchetti, & Curtis, 2005; Jonson- Reid, Drake et al, 2004; Leslie et al, 2005）。众所周知，接受心理咨询服务的父母患抑郁症的比例很高（Leschied, Chiodo, Whitehead & Hurley, 2005; Wolfe, 1999）。然而，在CW父母群体中，退出典型育儿项目的比例很高（Chaffin, 2007），参加心理健康服务的比例很低（johnson - reid, Drake, & Kohl, Under Review）。“儿童早期联系”（ECC）是由社区机构和研究团队合作设计的一种新型服务提供系统。采用随机设计，本R34测试了ECC预防儿童发育迟缓和后期精神健康障碍、预防复发性虐待以及预防或改善有幼儿的家庭中母亲抑郁和压力的能力。社区护理中心通过协调、合作和在这一高危人群中进行联合家访，创新地改善了现有的服务。ECC是翻译的，基于PI先前应用服务R01 （R01 MH61733; 2 R01 MH061733-04A1）的发现，并通过广泛的合作和初步可行性测试进一步发展，以评估参与者的接受程度。该R34是完善方案、评估参与者变化和评估未来有效性和实施R01的效应大小的必要下一步。现有的家访计划侧重于首次父母和初级预防，这意味着它们排除了连续家庭（Rapoport & O'Brien-Strain, 2001），或者是短期的，对解决父母和儿童心理健康需求的关注有限（Chaffin, 2007）。儿童保育中心通过独特的联合家访与儿童保育家庭接触，从而与长期的养育和病例管理支持无缝连接。ECC修改了家访筛查，将产妇抑郁和压力、儿童行为和心理健康以及育儿和社会支持纳入其中。儿童权利中心的工作人员接受了培训，以便更好地了解儿童权利中心的人口，以及如何让他们参与产妇心理健康等额外服务。儿童保育中心的家访远远超出了儿童保育服务的范围，为家庭提供长期的养育和个案管理支持，以便随着时间的推移与其他所需的服务建立联系。儿童保育中心试点项目随机分配了150个有0-3岁儿童的家庭，这些家庭是第一次使用(a)家庭儿童保育服务或(b)首次从寄养家庭团聚后的家庭服务。各组在基线和18个月时比较儿童认知、行为和心理健康结果、母亲抑郁、压力和社会支持、连续分娩累犯和育儿措施。在ECC条件下，我们在9个月时增加了临时筛选，测量ECC家访和其他所需服务的参与度和满意度，以及实施问题，如感知工人负担。假设阳性结果，研究结果将用于准备全面的R01测试。

DESCRIPTION (provided by applicant): Young children served by child welfare (CW) have very high rates of behavioral, mental health, and cognitive delays, yet these children are rarely connected to early childhood intervention (Cicchetti, & Curtis, 2005; Jonson- Reid, Drake et al, 2004; Leslie et al, 2005a). Parents served by CW are known to have a high rate of maternal depression (Leschied, Chiodo, Whitehead & Hurley, 2005; Wolfe, 1999). Among the CW parent population, however, drop-out from typical parenting programs is high (Chaffin, 2007) and participation in mental health services is low (Jonson-Reid, Drake, & Kohl, Under Review). "Early Childhood Connections" (ECC) is a novel service delivery system designed collaboratively by community agencies and the research team. Using a randomized design, this R34 tests ECC's ability to prevent child developmental delay and later mental health disorders, prevent recurrent maltreatment, and prevent or ameliorate maternal depression and stress in families with young children served by CW. ECC is innovative in its modification of existing services through coordination, collaboration and co-location (joint CW and ECC home visit) in this high risk population. ECC is translational, built from findings from the PI's prior applied services R01 (R01 MH61733; 2 R01 MH061733-04A1) and further developed through extensive collaboration and preliminary feasibility testing to assess participant acceptance. This R34 is the necessary next step to refine protocols, assess participant change, and estimate effect sizes for a future effectiveness and implementation R01. Existing home visiting programs focus on first time parents and primary prevention, meaning they exclude CW families (Rapoport & O'Brien-Strain, 2001), or are short-term with limited attention to addressing parent and child mental health needs (Chaffin, 2007). ECC engages CW families through a unique joint home visit so there is seamless connection to long-term parenting and case management support. ECC modifies home visiting screening to include maternal depression and stress, child behavior and mental health, and parenting and social support. ECC workers are trained to better understand the CW population and the means of engaging them in additional services, like maternal mental health. ECC home visiting extends well beyond CW services, providing families longer term parenting and case management support to make connections to other needed services over time. The ECC pilot randomly assigns (Usual care or ECC) 150 families with children 0-3 years who are first time users of either: (a) in-home CW services or (b) in-home services following a first reunification from foster care. Groups are compared at baseline and 18 months on child cognitive, behavioral and mental health outcomes, maternal depression, stress and social support, CW recidivism, and parenting measures. Within the ECC condition we add an interim screening at 9 months, measure engagement in and satisfaction with ECC home visiting and other needed services, and implementation issues like perceived worker burden. Presuming positive results, findings will be used to prepare for a full-scale R01 test. PUBLIC HEALTH RELEVANCE: Young children who receive in-home services for abuse or neglect are at high risk for later developmental delays and mental health problems and represent a significant cost to society both in terms of lost potential and public service system costs. Currently, few of these families are connected to available longer term early childhood services that may hold promise in preventing recurrent maltreatment and improving both caregiver and child outcomes. This R34 proposal supports a pilot study of Early Childhood Connections (ECC), a multi- level, innovative service model to improve behavioral and developmental outcomes for very young abused and neglected children and decrease depression and stress for their primary caregiver.